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Concussions Can Be More Likely In Practices Than In Games

NPR Health Blog - Mon, 05/11/2015 - 9:48am
Concussions Can Be More Likely In Practices Than In Games May 11, 2015 9:48 AM ET Listen to the Story 2:09
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Parents worry about a child getting a concussion in the heat of competition, but they also need to be thinking about what happens during practices, a study finds.

High school and college football players are more likely to suffer a concussion during practices than in a game, according a study published May 4 in JAMA Pediatrics. Here are the numbers:

  • In youth games, 54 percent of concussions happened during games.
  • In high school and college, just 42 percent of concussions happened during games, with 58 percent during practices.
  • Overall, college students had the highest rate of concussions during games, with 3.74 per 1,000 games compared to 2.01 for high schoolers and 2.38 for youths. High schoolers had the highest rates during practices.
Shots - Health News High Schools Seek A Safer Path Back From Concussion

The numbers are gleaned from three large injury surveillance systems that evaluated the 2012 and 2013 seasons of 118 youth football teams, 96 high school programs and 24 college programs. They were gathered by the Datalys Center for Sports Injury Research and Prevention Inc., in Indianapolis. They don't reflect the number of concussions, but rather players who reported having at least one concussion during the season.

Shots - Health News Football Players Drill Without Helmets To Curb Concussions

"The number of people exposed during practice is always higher than in games," says Tom Dompier, president of Datalys and lead author of the study, "because not all kids at the high school and college level will play in games." Players at that level log many more hours of practice time than do younger athletes.

Although it may be hard to change the intensity of a game, the authors note, "many strategies can be used during practice to limit player-to-player contact and other potentially injurious behaviors."

Some experiments are already underway. At the University of New Hampshire, half the squad practices without helmets. The school is monitoring players to see if that changes the number and force of hits.

Shots - Health News Sideline Robot Helps Trainers Spot Football Concussions

Chris Merritt, the head football coach at Christopher Columbus High School in Miami, has helped pilot USA Football's Heads Up program, which teaches blocking and tackling techniques that keep the head out of the way.

"You can't just sit there and line up four days a week and go full-go and tackle, bring to the ground," Merritt says. "There are too many opportunities that someone is going to hit helmet on helmet or helmet on the ground."

Football is the most popular sport in the nation for high school boys, according to the National Federation of State High School Associations, with 1.1 million boys playing. Track and field is a distant second, with 580,000 athletes.

Since boys start learning tackle football as young as age 5, it's vital that youth coaches teach safer techniques, Merritt says. Getting the message out can be tough, he says, because "they're not professionals for the most part; they're volunteers."

The NCAA was one of the funders of the study, along with USA Football and the National Athletic Trainers Association Research and Education Foundation.

An earlier version of this story ran in Shots on May 4. This version includes interviews from the May 11 Morning Edition story.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

For Headaches, A Lifestyle Change May Be Better Than A Doctor Visit

NPR Health Blog - Mon, 05/11/2015 - 3:22am
For Headaches, A Lifestyle Change May Be Better Than A Doctor Visit May 11, 2015 3:22 AM ET Listen to the Story 4:35
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Keith Negley for NPR

Terri Bradford has suffered debilitating headaches all her life. Some days the pain is so bad, she says, "By 11 o'clock in the morning, I'm on the couch in a darkened room with my head packed in ice."

"I've had two spinal taps; I've had so many nerve blocks I've lost count."

Over the years, Bradford, who is 50 years old and lives in Bedford, Mass., has searched desperately for pain relief. She's been to the doctor countless times for countless tests. "Everything I've had, I've had twice," she says. "I've had two spinal taps; I've had so many nerve blocks I've lost count."

Bradford is not alone. It's estimated that every year 12 million Americans go to the doctor seeking help for headaches. Nearly one quarter of the population suffers from recurrent severe tension headaches or migraines.

Shots - Health News Yes, It's A Headache. No, You Don't Need A Brain Scan

People who go to the doctor for headaches are increasingly likely to be sent for advanced testing and treatment, a study finds. That testing is expensive, it may not be necessary and it could even be harmful, says lead researcher Dr. John Mafi, of Beth Israel Deaconess Medical Center in Boston.

Mafi looked at the rates of advanced imaging like CT scans and MRIs in people with headaches, as well as referrals to other doctors, presumably specialists. He found that from 1999 to 2010, the number of diagnostic tests rose from 6.7 percent of all doctor visits to 13.9 percent. At the same time, referrals to other doctors increased from 6.9 percent to 13.2 percent. In other words, almost double what it was a decade ago.

Mafi says this isn't because more people are suffering headaches. The headache rate has remained virtually the same over the past decade. But what has changed is supply and demand. Today there are a lot more advanced diagnostic machines than there were a decade ago, and more patients are asking to be tested.

"There's a subconscious perception that fancier, more expensive tests are better and that equals better care."

"Patients are more assertive than ever before," Mafi says. "They do research online, are more informed and sometimes go to the doctor demanding, 'I think I need an MRI.' "

And while an informed patient is a good thing, Mafi says sometimes the patient gets it wrong. "I think there's a subconscious perception that more is better, and that fancier, more expensive tests are better and that equals better care."

Mafi's study did not include patients with tumors or other serious problems that can cause headaches. He only looked at otherwise healthy patients who suffered chronic headaches. And in these cases, repeated diagnostic testing can lead to further unnecessary procedures like biopsies.

On top of that, exposure to radiation in tests like CT scans adds up over time and can increase the risk of certain cancers.

For Terri Bradford, the years of searching for effective treatment proved futile. "I've been to four neurologists. A lot of them have given up on me because I haven't gotten any better," she says.

Shots - Health News Why Women Suffer More Migraines Than Men

Eventually Bradford ended up at Beth Israel Deaconess Medical Center, where neurologist Carolyn Bernstein directs the Comprehensive Headache Center. Bernstein says she sees lots of desperate patients like Bradford. "The majority of them have really been suffering a number of years and they're really miserable with the pain," Bernstein says. They say, " 'I hope you have a magic pill,' and of course there is no magic pill."

There is just no single reason why people get chronic headaches, although we do know that migraines have a genetic component and usually a trigger. "If you are a migraine sufferer and I expose you to the right trigger, you're going to have a migraine," Bernstein says.

But the triggers are different for different people. They can include poor diet, too much sugar or certain types of alcohol. Problems sleeping, stress, lack of exercise or a combination of any number of these things can cause chronic headaches.

At the headache center, patients receive a thorough medical history that includes headache patterns, disability and mood assessments. Then the center works with patients to try to identify what triggers their headaches and how they can avoid those triggers in the future.

Shots - Health News Electronic Headband Prevents Migraines With Tiny Jolts

Some people find relief through exercise. "I write an exercise prescription probably as often as I write a prescription for medication," Bernstein says. She acknowledges it's sometimes difficult to encourage a patient with cracking head pain to get up and exercise. But even a little can help, and according to Bernstein it doesn't have to be jogging for miles and miles. It can be yoga, tai chi or even just a little stretching.

A big lifestyle adjustment worked for Terri Bradford. She started exercising and changed her diet, giving up gluten, dairy and sugar. And she learned how to meditate to reduce stress. All these changes, she says, have made a huge difference. She has far fewer headaches and when she does have them, they're far less severe. "I'm finally healing," she says.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

For Headaches, A Lifestyle Change May Be Better Than A Doctor Visit

NPR Health Blog - Mon, 05/11/2015 - 3:22am
For Headaches, A Lifestyle Change May Be Better Than A Doctor Visit May 11, 2015 3:22 AM ET Listen to the Story 4:35
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Keith Negley for NPR

Terri Bradford has suffered debilitating headaches all her life. Some days the pain is so bad, she says, "By 11 o'clock in the morning, I'm on the couch in a darkened room with my head packed in ice."

"I've had two spinal taps; I've had so many nerve blocks I've lost count."

Over the years, Bradford, who is 50 years old and lives in Bedford, Mass., has searched desperately for pain relief. She's been to the doctor countless times for countless tests. "Everything I've had, I've had twice," she says. "I've had two spinal taps; I've had so many nerve blocks I've lost count."

Bradford is not alone. It's estimated that every year 12 million Americans go to the doctor seeking help for headaches. Nearly one quarter of the population suffers from recurrent severe tension headaches or migraines.

Shots - Health News Yes, It's A Headache. No, You Don't Need A Brain Scan

People who go to the doctor for headaches are increasingly likely to be sent for advanced testing and treatment, a study finds. That testing is expensive, it may not be necessary and it could even be harmful, says lead researcher Dr. John Mafi, of Beth Israel Deaconess Medical Center in Boston.

Mafi looked at the rates of advanced imaging like CT scans and MRIs in people with headaches, as well as referrals to other doctors, presumably specialists. He found that from 1999 to 2010, the number of diagnostic tests rose from 6.7 percent of all doctor visits to 13.9 percent. At the same time, referrals to other doctors increased from 6.9 percent to 13.2 percent. In other words, almost double what it was a decade ago.

Mafi says this isn't because more people are suffering headaches. The headache rate has remained virtually the same over the past decade. But what has changed is supply and demand. Today there are a lot more advanced diagnostic machines than there were a decade ago, and more patients are asking to be tested.

"There's a subconscious perception that fancier, more expensive tests are better and that equals better care."

"Patients are more assertive than ever before," Mafi says. "They do research online, are more informed and sometimes go to the doctor demanding, 'I think I need an MRI.' "

And while an informed patient is a good thing, Mafi says sometimes the patient gets it wrong. "I think there's a subconscious perception that more is better, and that fancier, more expensive tests are better and that equals better care."

Mafi's study did not include patients with tumors or other serious problems that can cause headaches. He only looked at otherwise healthy patients who suffered chronic headaches. And in these cases, repeated diagnostic testing can lead to further unnecessary procedures like biopsies.

On top of that, exposure to radiation in tests like CT scans adds up over time and can increase the risk of certain cancers.

For Terri Bradford, the years of searching for effective treatment proved futile. "I've been to four neurologists. A lot of them have given up on me because I haven't gotten any better," she says.

Shots - Health News Why Women Suffer More Migraines Than Men

Eventually Bradford ended up at Beth Israel Deaconess Medical Center, where neurologist Carolyn Bernstein directs the Comprehensive Headache Center. Bernstein says she sees lots of desperate patients like Bradford. "The majority of them have really been suffering a number of years and they're really miserable with the pain," Bernstein says. They say, " 'I hope you have a magic pill,' and of course there is no magic pill."

There is just no single reason why people get chronic headaches, although we do know that migraines have a genetic component and usually a trigger. "If you are a migraine sufferer and I expose you to the right trigger, you're going to have a migraine," Bernstein says.

But the triggers are different for different people. They can include poor diet, too much sugar or certain types of alcohol. Problems sleeping, stress, lack of exercise or a combination of any number of these things can cause chronic headaches.

At the headache center, patients receive a thorough medical history that includes headache patterns, disability and mood assessments. Then the center works with patients to try to identify what triggers their headaches and how they can avoid those triggers in the future.

Shots - Health News Electronic Headband Prevents Migraines With Tiny Jolts

Some people find relief through exercise. "I write an exercise prescription probably as often as I write a prescription for medication," Bernstein says. She acknowledges it's sometimes difficult to encourage a patient with cracking head pain to get up and exercise. But even a little can help, and according to Bernstein it doesn't have to be jogging for miles and miles. It can be yoga, tai chi or even just a little stretching.

A big lifestyle adjustment worked for Terri Bradford. She started exercising and changed her diet, giving up gluten, dairy and sugar. And she learned how to meditate to reduce stress. All these changes, she says, have made a huge difference. She has far fewer headaches and when she does have them, they're far less severe. "I'm finally healing," she says.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Can Volleyball Fight Crime? East Palo Alto Says, 'Game On'

NPR Health Blog - Sun, 05/10/2015 - 5:51am
Can Volleyball Fight Crime? East Palo Alto Says, 'Game On' May 10, 2015 5:51 AM ET

from

Jeremy Raff

In a FIT zone at Bell Street Park in East Palo Alto, Calif., friends from the neighborhood now gather regularly to play volleyball.

Jeremy Raff/KQED

Sia Kailahi is a tough-looking amateur boxer with dark eyeliner and tattoo-covered arms, but today her boxing gloves are off. She tosses up a volleyball and smacks a serve over a net.

A dozen people, laughing, keep the ball airborne at Bell Street Park in East Palo Alto, Calif. The park sits right next to a freeway exit in a city that has significant crime, despite being surrounded by affluent communities and technology companies. This park has a history as an easy stop-off point for buying and selling drugs.

But the visibility of the park may also be a reason the volleyball games here have helped reduce shootings in the area, according to a report from the University of California, Berkeley's Warren Institute on Law and Social Policy. These are not just pickup games, but part of East Palo Alto's FIT zones. The acronym is short for Fitness Improvement Training, but the program is equal parts community building and public health.

"I think people in the community can really appreciate us being out here making our city look like a livable place," says Kailahi, from the sidelines.

In 2012, the East Palo Alto police department started FIT zones in the places with the highest concentration of gunshots. Researchers had used data from ShotSpotter, a gunshot detection system, to select the sites.

Shots - Health News Most Teens Aren't Active Enough, And It's Not Always Their Fault

"The overall idea," says Melvin Gaines, who manages special projects for the city and has been with the project since it started, is for "residents to overwhelm the negative activities with positive things, so bad guys don't feel comfortable."

With police officers providing security, community members began riding bikes here, playing soccer and volleyball, and taking free nutrition classes from the staff of a nearby health clinic. Participation grew over time, and today dozens of people show up three times a week at different East Palo Alto parks.

Where Shootings Are Down

"We found that there was a statistically significant decline in shootings after the introduction of FIT zones," says Sarah Lawrence, director of policy analysis and program evaluation at the Warren Institute. "There is a huge potential for this type of initiative."

Shots - Health News Kids' Solo Playtime Unleashes 'Free-Range' Parenting Debate

When Lawrence and her colleagues compared FIT zone sites with neighborhoods with similar demographics over 17 months, they found that shootings were at least 27 percent lower in the FIT zones.

Shots - Health News To Make Children Healthier, A Doctor Prescribes A Trip To The Park

But the shooting reduction was not uniform within the FIT zones. Shootings decreased significantly around one site — Jack Farrell Park — but not at Martin Luther King Jr. Park.

The study does not explain why the intervention worked in only one of the parks, but Lawrence thinks their locations within their respective neighborhoods may offer a clue. Jack Farrell is central to the neighborhood, and open, so anyone walking by can see cops and kids playing together.

Adding team sports and community-building activities to this park didn't reduce shootings, researchers say. They suspect the park's remote location and obscured sightlines might be one reason.

Jeremy Raff/KQED

King park, by contrast, is so hidden that the city has put up a half-dozen signs with arrows leading visitors through the neighborhood to the park. The entrance is at the end of a cul-de-sac, and most of the park faces San Francisco Bay. That makes it harder for residents to notice that more residents and police are now using the park.

Public Health Approach

Beyond reducing the number of shootings, FIT zones are also about improving health.

"We know that communities like East Palo Alto suffer from high chronic disease rates, as well as high crime," Gaines says. "Assuming people are less active in East Palo Alto out of fear, we asked, 'Can we do something that addresses both?' And the answer was FIT zones."

Code Switch Retired Oakland Police Officer Recruits Locals To Police Their Own City

Lawrence credits the city's police chief at the time, Ron Davis, for implementing the program. Davis thought the police department had a role to play in the health of residents, Lawrence says. "He is a visionary guy."

In East Palo Alto, shootings are still dropping, and people at Bell Street Park say that a safe place to play has helped them improve their own health. A 14-year-old girl named Paluteia is here playing volleyball after rock-band practice.

"A lot of my family is overweight," she says, but "seeing other people work out — it's motivating. I can do more, and there are other people who will do it with me."

"When I started, I was 397 pounds," says Smokey, another regular at the game. "I weighed myself last Saturday, and I was 332 pounds."

Overall, health indicators tend to be much worse in East Palo Alto than in the surrounding affluent cities. Life expectancy is 62 years — 13 years under the San Mateo County average. Half of all kids in East Palo Alto are overweight or obese, compared with 34 percent in the rest of the county.

Changing Relationship Between Cops and Community

For some, FIT zones are an opportunity to interact differently with police, in a community where mistrust is common.

"In a dark place," said Kailahi, "I could be scared of them, and they could be scared of me — we don't know each other. But we're in the light; we're saying hello."

The police are "just like regular people," says Carl Mitchell, a high school student. "They come play games, they mess up, they do good. At least while they're here, they're acting good. Let's say that."

The cops' attitudes may also be changing. "I've really seen a shift in the police officers' perspective," Lawrence says. When the program started, she interviewed participating officers. "I asked why they were doing it, and quite frankly a lot of them said, 'I'm getting paid to exercise.' "

"Now," Lawrence says, "those same officers are saying, 'These are my kids,' and really taking ownership."

Brian Lee, an East Palo Alto police officer, struck up a conversation with a 5-year-old boy who was poking at a dead opossum during a FIT zone event. As they were chatting, Lee realized, "I knew his dad from the streets. He was a known drug dealer."

The boy's father had been murdered on Michigan Avenue, next to Jack Farrell Park, the same block where Lee and the boy now both ride bikes.

"I had personally taken his dad's homicide report," Lee says.

Lee has his own kids, so he could appreciate how sharp the boy was for his age, how bright a future he could have, given a chance. "Imagining this child's future," Lee says, was "one of the most powerful things I've felt."

Copyright 2015 KQED Public Media. To see more, visit http://www.kqed.org.
Categories: NPR Blogs

Can Volleyball Fight Crime? East Palo Alto Says, 'Game On'

NPR Health Blog - Sun, 05/10/2015 - 5:51am
Can Volleyball Fight Crime? East Palo Alto Says, 'Game On' May 10, 2015 5:51 AM ET

from

Jeremy Raff

In a FIT zone at Bell Street Park in East Palo Alto, Calif., friends from the neighborhood now gather regularly to play volleyball.

Jeremy Raff/KQED

Sia Kailahi is a tough-looking amateur boxer with dark eyeliner and tattoo-covered arms, but today her boxing gloves are off. She tosses up a volleyball and smacks a serve over a net.

A dozen people, laughing, keep the ball airborne at Bell Street Park in East Palo Alto, Calif. The park sits right next to a freeway exit in a city that has significant crime, despite being surrounded by affluent communities and technology companies. This park has a history as an easy stop-off point for buying and selling drugs.

But the visibility of the park may also be a reason the volleyball games here have helped reduce shootings in the area, according to a report from the University of California, Berkeley's Warren Institute on Law and Social Policy. These are not just pickup games, but part of East Palo Alto's FIT zones. The acronym is short for Fitness Improvement Training, but the program is equal parts community building and public health.

"I think people in the community can really appreciate us being out here making our city look like a livable place," says Kailahi, from the sidelines.

In 2012, the East Palo Alto police department started FIT zones in the places with the highest concentration of gunshots. Researchers had used data from ShotSpotter, a gunshot detection system, to select the sites.

Shots - Health News Most Teens Aren't Active Enough, And It's Not Always Their Fault

"The overall idea," says Melvin Gaines, who manages special projects for the city and has been with the project since it started, is for "residents to overwhelm the negative activities with positive things, so bad guys don't feel comfortable."

With police officers providing security, community members began riding bikes here, playing soccer and volleyball, and taking free nutrition classes from the staff of a nearby health clinic. Participation grew over time, and today dozens of people show up three times a week at different East Palo Alto parks.

Where Shootings Are Down

"We found that there was a statistically significant decline in shootings after the introduction of FIT zones," says Sarah Lawrence, director of policy analysis and program evaluation at the Warren Institute. "There is a huge potential for this type of initiative."

Shots - Health News Kids' Solo Playtime Unleashes 'Free-Range' Parenting Debate

When Lawrence and her colleagues compared FIT zone sites with neighborhoods with similar demographics over 17 months, they found that shootings were at least 27 percent lower in the FIT zones.

Shots - Health News To Make Children Healthier, A Doctor Prescribes A Trip To The Park

But the shooting reduction was not uniform within the FIT zones. Shootings decreased significantly around one site — Jack Farrell Park — but not at Martin Luther King Jr. Park.

The study does not explain why the intervention worked in only one of the parks, but Lawrence thinks their locations within their respective neighborhoods may offer a clue. Jack Farrell is central to the neighborhood, and open, so anyone walking by can see cops and kids playing together.

Adding team sports and community-building activities to this park didn't reduce shootings, researchers say. They suspect the park's remote location and obscured sightlines might be one reason.

Jeremy Raff/KQED

King park, by contrast, is so hidden that the city has put up a half-dozen signs with arrows leading visitors through the neighborhood to the park. The entrance is at the end of a cul-de-sac, and most of the park faces San Francisco Bay. That makes it harder for residents to notice that more residents and police are now using the park.

Public Health Approach

Beyond reducing the number of shootings, FIT zones are also about improving health.

"We know that communities like East Palo Alto suffer from high chronic disease rates, as well as high crime," Gaines says. "Assuming people are less active in East Palo Alto out of fear, we asked, 'Can we do something that addresses both?' And the answer was FIT zones."

Code Switch Retired Oakland Police Officer Recruits Locals To Police Their Own City

Lawrence credits the city's police chief at the time, Ron Davis, for implementing the program. Davis thought the police department had a role to play in the health of residents, Lawrence says. "He is a visionary guy."

In East Palo Alto, shootings are still dropping, and people at Bell Street Park say that a safe place to play has helped them improve their own health. A 14-year-old girl named Paluteia is here playing volleyball after rock-band practice.

"A lot of my family is overweight," she says, but "seeing other people work out — it's motivating. I can do more, and there are other people who will do it with me."

"When I started, I was 397 pounds," says Smokey, another regular at the game. "I weighed myself last Saturday, and I was 332 pounds."

Overall, health indicators tend to be much worse in East Palo Alto than in the surrounding affluent cities. Life expectancy is 62 years — 13 years under the San Mateo County average. Half of all kids in East Palo Alto are overweight or obese, compared with 34 percent in the rest of the county.

Changing Relationship Between Cops and Community

For some, FIT zones are an opportunity to interact differently with police, in a community where mistrust is common.

"In a dark place," said Kailahi, "I could be scared of them, and they could be scared of me — we don't know each other. But we're in the light; we're saying hello."

The police are "just like regular people," says Carl Mitchell, a high school student. "They come play games, they mess up, they do good. At least while they're here, they're acting good. Let's say that."

The cops' attitudes may also be changing. "I've really seen a shift in the police officers' perspective," Lawrence says. When the program started, she interviewed participating officers. "I asked why they were doing it, and quite frankly a lot of them said, 'I'm getting paid to exercise.' "

"Now," Lawrence says, "those same officers are saying, 'These are my kids,' and really taking ownership."

Brian Lee, an East Palo Alto police officer, struck up a conversation with a 5-year-old boy who was poking at a dead opossum during a FIT zone event. As they were chatting, Lee realized, "I knew his dad from the streets. He was a known drug dealer."

The boy's father had been murdered on Michigan Avenue, next to Jack Farrell Park, the same block where Lee and the boy now both ride bikes.

"I had personally taken his dad's homicide report," Lee says.

Lee has his own kids, so he could appreciate how sharp the boy was for his age, how bright a future he could have, given a chance. "Imagining this child's future," Lee says, was "one of the most powerful things I've felt."

Copyright 2015 KQED Public Media. To see more, visit http://www.kqed.org.
Categories: NPR Blogs

Despite Recent Measles Outbreak, Resistance To Vaccinations Persists

NPR Health Blog - Fri, 05/08/2015 - 11:51am
Despite Recent Measles Outbreak, Resistance To Vaccinations Persists May 08, 201511:51 AM ET $(function() { var pymParent = new pym.Parent( 'responsive-embed-vaccination-poll-20150506', 'http://apps.npr.org/dailygraphics/graphics/vaccination-poll-20150506/child.html', {} ); });

A measles outbreak linked to Disneyland has exposed gaps in immunization against the highly infectious disease.

All told this year, 169 people in 20 states and the District of Columbia were reported sick with measles through May 1, according to the Centers for Disease Control and Prevention.

Shots - Health News Rise In Measles Cases Marks A 'Wake-Up Call' For U.S.

Childhood vaccination remains a potent public health weapon against the spread of many illnesses, including measles. But objections and worries about vaccination remain, too.

With the recent measles cases in mind, we asked more than 3,000 Americans about their attitudes toward vaccination in the latest NPR Truven Health Analytics Health Poll.

We put the same questions to adults with children living at home and those without kids. We called them on land lines, cellphones and reached them online. Here's what we found.

Shots - Health News To Get Parents To Vaccinate Their Kids, Don't Ask. Just Tell

Adults in 28 percent of households with kids said they had concerns about vaccines compared with about 13 percent in households without kids.

Among the adults with kids at home who had concerns, the top worries were side effects at 36 percent and that vaccines cause illnesses at 27 percent. In households without kids that had vaccine concerns, side effects were the reason expressed by 26 percent and a cause of illnesses at 23 percent. Many households without kids — 19 percent — were also concerned about the public health consequences of kids not getting vaccinated.

Shots - Health News A Boy Who Had Cancer Faces Measles Risk From The Unvaccinated

We were particularly curious about people's views on whether vaccination exemptions should be allowed for nonmedical reasons. Among households with children, 38 percent supported exemptions based on religious or personal beliefs. In households without children, the support for exemptions was 10 percentage-points lower at 28 percent.

We also asked about compulsory vaccination for kids depending on what type of school they attended. Adults, regardless of whether or not they had kids at home, had the same responses: 91 percent in favor of public schoolchildren getting all mandatory vaccinations unless there was a medical reason not to do so. When the question was broadened to kids in all kinds of schools, the support for mandatory vaccination dropped to 83 percent among households with children compared with 89 percent in households without them.

"Vaccinations have, somewhat surprisingly, emerged as a polarizing topic, and it's clear from these results that some parents are approaching them with trepidation," Dr. Michael Taylor, chief medical officer at Truven Health Analytics, said in a statement. "The very preventable cases we've seen over the last year, such as a spread of measles that were traced back to Disneyland, underscore how important it is that parents not rush into decisions based on misinformation and conjecture."

The overall margin for error for the poll, which was conducted during the first half of March, is plus or minus 1.8 percentage points. You can find the full set of questions and responses here and the results of previous NPR-Truven Health Analytics Health Polls here.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Despite Recent Measles Outbreak, Resistance To Vaccinations Persists

NPR Health Blog - Fri, 05/08/2015 - 11:51am
Despite Recent Measles Outbreak, Resistance To Vaccinations Persists May 08, 201511:51 AM ET $(function() { var pymParent = new pym.Parent( 'responsive-embed-vaccination-poll-20150506', 'http://apps.npr.org/dailygraphics/graphics/vaccination-poll-20150506/child.html', {} ); });

A measles outbreak linked to Disneyland has exposed gaps in immunization against the highly infectious disease.

All told this year, 169 people in 20 states and the District of Columbia were reported sick with measles through May 1, according to the Centers for Disease Control and Prevention.

Shots - Health News Rise In Measles Cases Marks A 'Wake-Up Call' For U.S.

Childhood vaccination remains a potent public health weapon against the spread of many illnesses, including measles. But objections and worries about vaccination remain, too.

With the recent measles cases in mind, we asked more than 3,000 Americans about their attitudes toward vaccination in the latest NPR Truven Health Analytics Health Poll.

We put the same questions to adults with children living at home and those without kids. We called them on land lines, cellphones and reached them online. Here's what we found.

Shots - Health News To Get Parents To Vaccinate Their Kids, Don't Ask. Just Tell

Adults in 28 percent of households with kids said they had concerns about vaccines compared with about 13 percent in households without kids.

Among the adults with kids at home who had concerns, the top worries were side effects at 36 percent and that vaccines cause illnesses at 27 percent. In households without kids that had vaccine concerns, side effects were the reason expressed by 26 percent and a cause of illnesses at 23 percent. Many households without kids — 19 percent — were also concerned about the public health consequences of kids not getting vaccinated.

Shots - Health News A Boy Who Had Cancer Faces Measles Risk From The Unvaccinated

We were particularly curious about people's views on whether vaccination exemptions should be allowed for nonmedical reasons. Among households with children, 38 percent supported exemptions based on religious or personal beliefs. In households without children, the support for exemptions was 10 percentage-points lower at 28 percent.

We also asked about compulsory vaccination for kids depending on what type of school they attended. Adults, regardless of whether or not they had kids at home, had the same responses: 91 percent in favor of public schoolchildren getting all mandatory vaccinations unless there was a medical reason not to do so. When the question was broadened to kids in all kinds of schools, the support for mandatory vaccination dropped to 83 percent among households with children compared with 89 percent in households without them.

"Vaccinations have, somewhat surprisingly, emerged as a polarizing topic, and it's clear from these results that some parents are approaching them with trepidation," Dr. Michael Taylor, chief medical officer at Truven Health Analytics, said in a statement. "The very preventable cases we've seen over the last year, such as a spread of measles that were traced back to Disneyland, underscore how important it is that parents not rush into decisions based on misinformation and conjecture."

The overall margin for error for the poll, which was conducted during the first half of March, is plus or minus 1.8 percentage points. You can find the full set of questions and responses here and the results of previous NPR-Truven Health Analytics Health Polls here.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

People Have Misconceptions About Miscarriage, And That Can Hurt

NPR Health Blog - Fri, 05/08/2015 - 9:05am
People Have Misconceptions About Miscarriage, And That Can Hurt May 08, 2015 9:05 AM ET Katherine Hobson

Most people think a miscarriage is rare, and many believe that if a woman loses a pregnancy that she brought it upon herself. Neither of those things is true, but the enduring beliefs cause great pain to women and their partners.

In fact, almost half of people who have experienced a miscarriage or whose partner has had one feel guilty, according to a survey to be published Monday in Obstetrics & Gynecology. More than a quarter of them felt shame. Many felt they'd lost a child.

"It's irrational, but there is such a deep shame attached to not being able to carry a baby to term.... I don't want another baby, I want THIS baby."

When NPR asked visitors to its Facebook page to tell us what they wished people knew about miscarriage, the response was overwhelming — 200 emails and counting, many heartbreaking. Their sentiments often echoed what the survey found.

"I wish people knew how much it's possible to miss a person you have never met, and to mark time by their absence," wrote one woman. "I will always think about how old my baby would be now and what our lives would be like if I hadn't lost the pregnancy."

The survey came about after Dr. Zev Williams realized that many of his patients had misconceptions about miscarriage. "I'd tell them how common a miscarriage was, and they seemed shocked," says Williams, an OB-GYN who directs the Program for Early and Recurrent Pregnancy Loss at Einstein College of Medicine of Yeshiva University and Montefiore Medical Center in New York.

Opinion After Miscarriage, Missing The Luxury Of Grieving

In fact, between 15 percent and 20 percent of clinically recognized pregnancies end in miscarriage, defined as a pregnancy loss earlier than 20 weeks of gestation. (Pregnancy loss after that point is called a stillbirth.) Miscarriage is actually "by far the most common complication of pregnancy," says Williams. He and his colleagues wanted to find out how widespread some of the mistaken beliefs about miscarriage are.

They asked 1,084 adults about miscarriage and its causes. They also asked the 15 percent of survey respondents who had suffered a miscarriage, or whose partner had, about their experience. The results echoed what he'd seen in his patients: Some 55 percent of all respondents believed that miscarriage occurred in 5 percent or less of all pregnancies.

"I felt, and feel, literally broken, and betrayed by my body."

The cultural silence around miscarriage contributes to those misunderstandings, Williams says. "A lot of other conditions that people used to speak of only in hushed tones, like cancer and AIDS, we speak about a lot more," he says.

Not so for miscarriage. Because early pregnancy loss is so common, women are often advised not to share their pregnancy news with friends and family until the start of the second trimester. At that point the chance of miscarriage has drastically declined. But that secrecy means women who do miscarry in the first trimester may not get the support they need, Williams says.

"It's bizarre that the topic is so taboo," wrote one reader on Facebook. "I really feel an obligation now, having had a miscarriage, to mention my miscarriage when I'm talking about fertility or the process of conceiving or childbirth." She added a sentiment that many other women expressed: "I felt alone until I realized there is this big, secret miscarriage club — one that nobody wants to be a member of — and when I realized it existed, I felt angry that no one told me they had active membership."

"Many women in my family had suffered one or more, and I had no idea until I had one myself."

Chromosomal abnormalities in the fetus cause 60 percent of miscarriages. A handful of other medical conditions are also known to cause miscarriage. Most survey respondents knew that genetic or medical problems were the most common cause of early pregnancy loss. But they also mistakenly believed that other factors could trigger a miscarriage: a stressful event (76 percent); lifting something heavy (64 percent); previous use of contraception like an IUD (28 percent) or birth control pills (22 percent); and even an argument (21 percent). Some 22 percent believed that lifestyle choices, like using drugs, tobacco or alcohol, were the single biggest cause of miscarriages. That's not true.

Those who shared their experiences with NPR said many of those myths were repeated back to them by friends, family or colleagues after their own miscarriages. One said someone blamed her high heels. That kind of talk can be incredibly painful, even if you know you have the facts on your side.

"I felt alone until I realized there is this big, secret miscarriage club — one that nobody wants to be a member of — and when I realized it existed, I felt angry that no one told me they had active membership."

"I wish people understood that miscarriages are the flip side of the coin," wrote one woman. "If you've had a healthy pregnancy that went full term — you won a lottery. Short of obvious substance abuse and bull riding — your healthy baby is not the result of anything you did or didn't do. As much as you want to think you are in control — you aren't. And the same goes when I lost each pregnancy — as much as I wish I could have been — it was not in my control."

The feelings of guilt, shame and enormous loss reported in the survey were a common theme among those who told their stories to NPR. "I felt, and feel, literally broken, and betrayed by my body," wrote one woman. "It's irrational, but there is such a deep shame attached to not being able to carry a baby to term.... I don't want another baby, I want THIS baby, the one I thought I would have, the one I started planning for, hoping for, dreaming about, talking to. All that got taken away from me."

Shots - Health News Are You Sick, And Sick Of Hearing 'Everything Happens For A Reason'?

Not everyone was so deeply affected; some said the miscarriage came as a relief, either because the pregnancy was unwanted, or because they'd known something wasn't quite right. Or they said it was painful at the time, but that they'd moved on and weren't particularly haunted by the loss. "You have every right to feel ALL of your emotions you have," wrote one person. "Whether you feel grief or relief, your emotions are never wrong."

But because the loss can be so great, people said they wished others would acknowledge a miscarriage without reverting to a laundry list of well-intentioned but hurtful lines: "Well, at least you know you can get pregnant." (One reader said this was particularly upsetting after her seventh miscarriage.) "You can always try again." "If you adopt, you'll get pregnant." "It happens for a reason." "It's God's plan." (That, wrote another reader, sounds an awful lot like "God doesn't want you to be a parent.")

My husband "had hopes and dreams and fears and so much joy tied up into 9.5 weeks of cells."

Far better, people said, is to simply say, "I'm sorry. Is there anything I can do for you?"

Over and over again, we heard a wish that there was more private and public discussion of miscarriage. "Many women in my family had suffered one or more, and I had no idea until I had one myself," wrote one woman. "I felt that no one I knew had gone through this."

Several readers said this code of silence was even stronger for the partners of women who miscarry. One reader wrote that her husband "had hopes and dreams and fears and so much joy tied up into 9.5 weeks of cells," but he didn't get time off work, flowers or well-wishes from colleagues or visits from friends to "listen to him cry," as she did. Instead, "He had to suffer alone."

The new survey found that 46 percent of respondents who'd miscarried said they felt less alone when friends talked about their own miscarriages. Even a celebrity's disclosure of miscarriage helped.

"I wish people knew how much it's possible to miss a person you have never met, and to mark time by their absence."

One person who recently suffered a miscarriage summed it up: "While I'm definitely still healing emotionally, I would be happy to talk more about it. So many people grieve silently, but I've found that talking really helps the most."

That's the kind of conversation that Williams says he and his co-authors would like to spark with their survey. "Miscarriage is ancient. It's always been there." And all too often, he says, "people often blame themselves and don't discuss it."

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

People Have Misconceptions About Miscarriage, And That Can Hurt

NPR Health Blog - Fri, 05/08/2015 - 9:05am
People Have Misconceptions About Miscarriage, And That Can Hurt May 08, 2015 9:05 AM ET Katherine Hobson

Most people think a miscarriage is rare, and many believe that if a woman loses a pregnancy that she brought it upon herself. Neither of those things is true, but the enduring beliefs cause great pain to women and their partners.

In fact, almost half of people who have experienced a miscarriage or whose partner has had one feel guilty, according to a survey to be published Monday in Obstetrics & Gynecology. More than a quarter of them felt shame. Many felt they'd lost a child.

"It's irrational, but there is such a deep shame attached to not being able to carry a baby to term.... I don't want another baby, I want THIS baby."

When NPR asked visitors to its Facebook page to tell us what they wished people knew about miscarriage, the response was overwhelming — 200 emails and counting, many heartbreaking. Their sentiments often echoed what the survey found.

"I wish people knew how much it's possible to miss a person you have never met, and to mark time by their absence," wrote one woman. "I will always think about how old my baby would be now and what our lives would be like if I hadn't lost the pregnancy."

The survey came about after Dr. Zev Williams realized that many of his patients had misconceptions about miscarriage. "I'd tell them how common a miscarriage was, and they seemed shocked," says Williams, an OB-GYN who directs the Program for Early and Recurrent Pregnancy Loss at Einstein College of Medicine of Yeshiva University and Montefiore Medical Center in New York.

Opinion After Miscarriage, Missing The Luxury Of Grieving

In fact, between 15 percent and 20 percent of clinically recognized pregnancies end in miscarriage, defined as a pregnancy loss earlier than 20 weeks of gestation. (Pregnancy loss after that point is called a stillbirth.) Miscarriage is actually "by far the most common complication of pregnancy," says Williams. He and his colleagues wanted to find out how widespread some of the mistaken beliefs about miscarriage are.

They asked 1,084 adults about miscarriage and its causes. They also asked the 15 percent of survey respondents who had suffered a miscarriage, or whose partner had, about their experience. The results echoed what he'd seen in his patients: Some 55 percent of all respondents believed that miscarriage occurred in 5 percent or less of all pregnancies.

"I felt, and feel, literally broken, and betrayed by my body."

The cultural silence around miscarriage contributes to those misunderstandings, Williams says. "A lot of other conditions that people used to speak of only in hushed tones, like cancer and AIDS, we speak about a lot more," he says.

Not so for miscarriage. Because early pregnancy loss is so common, women are often advised not to share their pregnancy news with friends and family until the start of the second trimester. At that point the chance of miscarriage has drastically declined. But that secrecy means women who do miscarry in the first trimester may not get the support they need, Williams says.

"It's bizarre that the topic is so taboo," wrote one reader on Facebook. "I really feel an obligation now, having had a miscarriage, to mention my miscarriage when I'm talking about fertility or the process of conceiving or childbirth." She added a sentiment that many other women expressed: "I felt alone until I realized there is this big, secret miscarriage club — one that nobody wants to be a member of — and when I realized it existed, I felt angry that no one told me they had active membership."

"Many women in my family had suffered one or more, and I had no idea until I had one myself."

Chromosomal abnormalities in the fetus cause 60 percent of miscarriages. A handful of other medical conditions are also known to cause miscarriage. Most survey respondents knew that genetic or medical problems were the most common cause of early pregnancy loss. But they also mistakenly believed that other factors could trigger a miscarriage: a stressful event (76 percent); lifting something heavy (64 percent); previous use of contraception like an IUD (28 percent) or birth control pills (22 percent); and even an argument (21 percent). Some 22 percent believed that lifestyle choices, like using drugs, tobacco or alcohol, were the single biggest cause of miscarriages. That's not true.

Those who shared their experiences with NPR said many of those myths were repeated back to them by friends, family or colleagues after their own miscarriages. One said someone blamed her high heels. That kind of talk can be incredibly painful, even if you know you have the facts on your side.

"I felt alone until I realized there is this big, secret miscarriage club — one that nobody wants to be a member of — and when I realized it existed, I felt angry that no one told me they had active membership."

"I wish people understood that miscarriages are the flip side of the coin," wrote one woman. "If you've had a healthy pregnancy that went full term — you won a lottery. Short of obvious substance abuse and bull riding — your healthy baby is not the result of anything you did or didn't do. As much as you want to think you are in control — you aren't. And the same goes when I lost each pregnancy — as much as I wish I could have been — it was not in my control."

The feelings of guilt, shame and enormous loss reported in the survey were a common theme among those who told their stories to NPR. "I felt, and feel, literally broken, and betrayed by my body," wrote one woman. "It's irrational, but there is such a deep shame attached to not being able to carry a baby to term.... I don't want another baby, I want THIS baby, the one I thought I would have, the one I started planning for, hoping for, dreaming about, talking to. All that got taken away from me."

Shots - Health News Are You Sick, And Sick Of Hearing 'Everything Happens For A Reason'?

Not everyone was so deeply affected; some said the miscarriage came as a relief, either because the pregnancy was unwanted, or because they'd known something wasn't quite right. Or they said it was painful at the time, but that they'd moved on and weren't particularly haunted by the loss. "You have every right to feel ALL of your emotions you have," wrote one person. "Whether you feel grief or relief, your emotions are never wrong."

But because the loss can be so great, people said they wished others would acknowledge a miscarriage without reverting to a laundry list of well-intentioned but hurtful lines: "Well, at least you know you can get pregnant." (One reader said this was particularly upsetting after her seventh miscarriage.) "You can always try again." "If you adopt, you'll get pregnant." "It happens for a reason." "It's God's plan." (That, wrote another reader, sounds an awful lot like "God doesn't want you to be a parent.")

My husband "had hopes and dreams and fears and so much joy tied up into 9.5 weeks of cells."

Far better, people said, is to simply say, "I'm sorry. Is there anything I can do for you?"

Over and over again, we heard a wish that there was more private and public discussion of miscarriage. "Many women in my family had suffered one or more, and I had no idea until I had one myself," wrote one woman. "I felt that no one I knew had gone through this."

Several readers said this code of silence was even stronger for the partners of women who miscarry. One reader wrote that her husband "had hopes and dreams and fears and so much joy tied up into 9.5 weeks of cells," but he didn't get time off work, flowers or well-wishes from colleagues or visits from friends to "listen to him cry," as she did. Instead, "He had to suffer alone."

The new survey found that 46 percent of respondents who'd miscarried said they felt less alone when friends talked about their own miscarriages. Even a celebrity's disclosure of miscarriage helped.

"I wish people knew how much it's possible to miss a person you have never met, and to mark time by their absence."

One person who recently suffered a miscarriage summed it up: "While I'm definitely still healing emotionally, I would be happy to talk more about it. So many people grieve silently, but I've found that talking really helps the most."

That's the kind of conversation that Williams says he and his co-authors would like to spark with their survey. "Miscarriage is ancient. It's always been there." And all too often, he says, "people often blame themselves and don't discuss it."

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Cancer Spawns A Construction Boom In Cleveland

NPR Health Blog - Fri, 05/08/2015 - 4:39am
Cancer Spawns A Construction Boom In Cleveland May 08, 2015 4:39 AM ET

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Sarah Jane Tribble Listen to the Story 3:53
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An architectural rendering of the Cleveland Clinic's planned cancer center.

Courtesy of the Cleveland Clinic

It's difficult to imagine that a seven-story glass building will soon take the place of what's now a vast hole near the corner of Carnegie Avenue and 105th Street in Cleveland. But Cliff Kazmierczak, who is with Turner Construction and overseeing the transformation, points to the gray sky, tracing a silhouette with his fingertips. In two years, he says, the Cleveland Clinic's nearly $300 million cancer center is slated to open here.

Cliff Kazmierczak of Turner Construction oversees the building of the Cleveland Clinic's new cancer outpatient center.

Sarah Jane Tribble/WCPN

"The big thing is to make the patient comfortable with the treatments that they're going through," he says of the building's design. "So lighting, light colors, [and] as much natural light as possible are always very important to cancer patients."

Kazmierczak came to this project after overseeing construction of the cancer hospital at Ohio State University a few hours south of here. All around the U.S., the health care industry is building up to take care of an expected influx of cancer patients.

The Advisory Board Company, a firm that does health care consulting, works with hospitals and doctors. Last year it found that about 25 percent of its members that have oncology departments were either constructing a cancer center or had built one in the past three years. The Advisory Board's Deirdre Fuller says people are more likely to get cancer as they get older.

"Now that everyone is looking forward and seeing the aging of the baby boomers," she says, "it's certainly adding some fuel to that fire."

Shots - Health News Big Bills A Hidden Side Effect Of Cancer Treatment

And most boomers will get health insurance through Medicare — which is a steady paycheck for hospitals.

Dr. Brian Bolwell heads the Cleveland Clinic's cancer institute. He says hospitals have to meet the need.

"In the past five years, volumes go up, depending on location, between 5 and 10 percent a year," Bolwell says. "And there's no end in sight to that volume of growth."

The Cleveland Clinic, along with its local competitor, University Hospitals, treat about 70 percent of the region's cancer patients. And when the Cleveland Clinic opens its new center, the two will be located within a five-minute drive of each other.

Historically, state governments have required hospitals to meet a certificate of need before building a hospital. But beginning in the late 1980s, states across the country began deregulating. Ohio's certificate of need requirements for hospitals ended in the late 1990s, though it still requires it for long-term care facilities.

Shots - Health News Losing A Hospital In The Heart Of A Small City

Dr. Nathan Levitan, who heads the cancer center at University Hospitals, doesn't seem worried about the competition. His 4-year-old hospital, he says, is mostly full every day.

"We discharged over 11,000 patients with cancer in 2014," Levitan says, "which is about a 20 percent increase over just a few years beforehand."

He says that's because both hospitals employ and contract with thousands of doctors. And in the world of cancer care, doctors have a lot of influence.

People usually don't shop for cancer treatment until they are diagnosed, and at that moment their doctor's advice on where to go matters a lot.

Shots - Health News Kidney Dialysis Company Expands Into The Hospital Business

Bill Ryan leads a hospital advocacy group in Cleveland. He says that with so many expected patients, building is good for a hospital's bottom line, and good for patients.

"If you can run enough procedures through a facility, you're going to get some economies of scale that will generate [a profit] margin," he says. "The other thing you get when you run enough procedures through a facility, is a level of expertise that improves the quality of care that the individual gets."

And when talking about the future of cancer care, hospital leaders tend to talk about quality. They insist that focusing on the quality of care for patients will eventually lower the cost to patients, too.

This story is part of a reporting partnership with NPR, WCPN and Kaiser Health News.

Copyright 2015 Cleveland Public Radio. To see more, visit http://www.wcpn.org.
Categories: NPR Blogs

Cancer Spawns A Construction Boom In Cleveland

NPR Health Blog - Fri, 05/08/2015 - 4:39am
Cancer Spawns A Construction Boom In Cleveland May 08, 2015 4:39 AM ET

from

Sarah Jane Tribble Listen to the Story 3:53
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An architectural rendering of the Cleveland Clinic's planned cancer center.

Courtesy of the Cleveland Clinic

It's difficult to imagine that a seven-story glass building will soon take the place of what's now a vast hole near the corner of Carnegie Avenue and 105th Street in Cleveland. But Cliff Kazmierczak, who is with Turner Construction and overseeing the transformation, points to the gray sky, tracing a silhouette with his fingertips. In two years, he says, the Cleveland Clinic's nearly $300 million cancer center is slated to open here.

Cliff Kazmierczak of Turner Construction oversees the building of the Cleveland Clinic's new cancer outpatient center.

Sarah Jane Tribble/WCPN

"The big thing is to make the patient comfortable with the treatments that they're going through," he says of the building's design. "So lighting, light colors, [and] as much natural light as possible are always very important to cancer patients."

Kazmierczak came to this project after overseeing construction of the cancer hospital at Ohio State University a few hours south of here. All around the U.S., the health care industry is building up to take care of an expected influx of cancer patients.

The Advisory Board Company, a firm that does health care consulting, works with hospitals and doctors. Last year it found that about 25 percent of its members that have oncology departments were either constructing a cancer center or had built one in the past three years. The Advisory Board's Deirdre Fuller says people are more likely to get cancer as they get older.

"Now that everyone is looking forward and seeing the aging of the baby boomers," she says, "it's certainly adding some fuel to that fire."

Shots - Health News Big Bills A Hidden Side Effect Of Cancer Treatment

And most boomers will get health insurance through Medicare — which is a steady paycheck for hospitals.

Dr. Brian Bolwell heads the Cleveland Clinic's cancer institute. He says hospitals have to meet the need.

"In the past five years, volumes go up, depending on location, between 5 and 10 percent a year," Bolwell says. "And there's no end in sight to that volume of growth."

The Cleveland Clinic, along with its local competitor, University Hospitals, treat about 70 percent of the region's cancer patients. And when the Cleveland Clinic opens its new center, the two will be located within a five-minute drive of each other.

Historically, state governments have required hospitals to meet a certificate of need before building a hospital. But beginning in the late 1980s, states across the country began deregulating. Ohio's certificate of need requirements for hospitals ended in the late 1990s, though it still requires it for long-term care facilities.

Shots - Health News Losing A Hospital In The Heart Of A Small City

Dr. Nathan Levitan, who heads the cancer center at University Hospitals, doesn't seem worried about the competition. His 4-year-old hospital, he says, is mostly full every day.

"We discharged over 11,000 patients with cancer in 2014," Levitan says, "which is about a 20 percent increase over just a few years beforehand."

He says that's because both hospitals employ and contract with thousands of doctors. And in the world of cancer care, doctors have a lot of influence.

People usually don't shop for cancer treatment until they are diagnosed, and at that moment their doctor's advice on where to go matters a lot.

Shots - Health News Kidney Dialysis Company Expands Into The Hospital Business

Bill Ryan leads a hospital advocacy group in Cleveland. He says that with so many expected patients, building is good for a hospital's bottom line, and good for patients.

"If you can run enough procedures through a facility, you're going to get some economies of scale that will generate [a profit] margin," he says. "The other thing you get when you run enough procedures through a facility, is a level of expertise that improves the quality of care that the individual gets."

And when talking about the future of cancer care, hospital leaders tend to talk about quality. They insist that focusing on the quality of care for patients will eventually lower the cost to patients, too.

This story is part of a reporting partnership with NPR, WCPN and Kaiser Health News.

Copyright 2015 Cleveland Public Radio. To see more, visit http://www.wcpn.org.
Categories: NPR Blogs

Are You Sick, And Sick Of Hearing 'Everything Happens For A Reason'?

NPR Health Blog - Thu, 05/07/2015 - 4:56pm
Are You Sick, And Sick Of Hearing 'Everything Happens For A Reason'? May 07, 2015 4:56 PM ET Listen to the Story 3:00
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Courtesy of Emily McDowell Studio

When a friend or loved one gets sick — really, seriously sick — it's hard to know what to say. So some of us say nothing. Which seems better than saying the wrong thing, though people do that too.

Emily McDowell has heard it all.

Courtesy of Emily McDowell Studio

Los Angeles graphic designer Emily McDowell's solution to this dilemma are what she calls Empathy Cards. When someone is seriously ill, she says, the usual "Get Well Soon" won't do. Because you might not, she says. At least not soon.

McDowell knows this from experience. She's a 15-year survivor of Hodgkin lymphoma. She was just 24 when she was diagnosed.

"The most difficult thing about my illness was the fact that it was so lonely," she says. One of the reasons was "friends and family either disappearing because they didn't know what to say or well-intentioned people saying the wrong thing. So one of the most difficult things about being sick was feeling really alienated from everyone that I knew."

McDowell says she often got well-meaning advice on Internet "cures." "The thing that I felt when it was happening to me was: 'I also have the Internet. And I really appreciate you trying to help, but believe me, I've spent way too many hours Googling my own condition and any possible treatments. And I've made the decisions to do the things that I'm doing because I felt like they were the best choices for me.' "

Courtesy of Emily McDowell Studio

And then there's "Everything happens for a reason." With time and distance, some people do come to that conclusion on their own, McDowell says. But "hearing that immediately after some shocking or terrible thing happens in your life is generally not what people want to hear."

What is it with people who respond to the news of your dire prognosis with more bad news? That was the impetus for "When life gives you lemons, I won't tell you a story about my cousin's friend who died of lemons."

"This is a weird thing that people do. When they found out ... that I had cancer, it was 'Oh yeah, so and so I know had cancer and they died.' ... It's like sort of knee-jerk 'Oh, I can relate to this' and then they don't really think about the ending. ... But it's really surprising how many people this happens to and how common that is as a reaction."

And wouldn't it be great if no one ever referred to your illness as a "journey"? "With time and distance some people do come to that conclusion on their own that this ... feels like a journey," McDowell says. "But a lot of people really feel like 'If this is a journey I'd like my ticket refunded,' or 'This is a journey to hell and back.' "

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

DNA 'Printing' A Big Boon To Research, But Some Raise Concerns

NPR Health Blog - Thu, 05/07/2015 - 4:56pm
DNA 'Printing' A Big Boon To Research, But Some Raise Concerns May 07, 2015 4:56 PM ET Listen to the Story 6:24
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Cambrian Genomics says that what it calls a DNA printer is essentially a DNA sorter — it quickly spots and collects the desired, tailored stretch of DNA.

Courtesy of Cambrian Genomics

Here's something that might sound strange: There are companies now that print and sell DNA.

This trend — which uses the term "print" in the sense of making a bunch of copies speedily — is making particular stretches of DNA much cheaper and easier to obtain than ever before. That excites many scientists who are keen to use these tailored strings of genetic instructions to do all sorts of things, ranging from finding new medical treatments to genetically engineering better crops.

"Many of the figures in the synthetic biology field are not shy at all about embracing that prospect that we're going to use synthetic biology to redesign humanity and to engineer the traits in our children. And that I find extremely disturbing."

"So much good can be done," says Austen Heinz, CEO of Cambrian Genomics in San Francisco, one of the companies selling these stretches of DNA.

But some of the ways Heinz and others talk about the possible uses of the technology also worries some people who are keeping tabs on the trend.

"I have significant concerns," says Marcy Darnovsky, who directs the Center for Genetics and Society, a genetics watchdog group.

A number of companies have been taking advantage of several recent advances in technology to produce DNA quickly and cheaply. Heinz says his company has made the process even cheaper.

"Everyone else that makes DNA, makes DNA incorrectly and then tries to fix it," Heinz says. "We don't fix it. We just see what's good, what's bad and then we use the correct pieces."

Shots - Health News Chemists Expand Nature's Genetic Alphabet Science DNA Transplant Transforms Bacteria

The company does that by putting chunks of their DNA on tiny metal beads that emit different colors. That lets a computer scan millions of pieces of DNA to find the right ones.

"So we just take a picture, change a filter, take a picture, change a filter, take a picture, change a filter. And we read the sequences," he says.

It's basically a high-tech version of a spell-checker.

Then Cambrian chooses and "prints" the correct stretch of DNA by firing a computer-controlled laser beam at a glass tray holding millions of these tiny metal beads, each one coated with DNA. The impact of the laser propels the bead carrying the correct DNA into a tray.

"The DNA laser 'printer' is essentially a sorter," he says. It can produce any strand of DNA, made to order, and Heinz can crank out a lot of DNA this way.

"We can make DNA that would be used to make a virus that could target your cancer cells. And I think it can be helpful for dealing with some of the problems that humans have created. If we can make plants that can suck more carbon out of the atmosphere, we can deal with global warming."

So far, the company's main customers are drug companies, which use the strings of DNA Cambrian Genomics makes to do things like genetically engineer microbes to try to find new medicines.

"They may be interested in making a protein that attacks a cancer cell with some kind of killer payload," he says.

Other users are genetically engineering plants to try to make them grow better. But Heinz envisions a day when mass-produced DNA can genetically engineer people — or let anyone use DNA like computer code to design their own organisms.

"I think some people will find the process of designing and making organisms just fun, in and of itself," he says.

But this sort of talk makes some people nervous.

"Heinz talks openly about everybody being able to create entirely novel creatures," Darnovsky says. "Is that what we want? Do we want anybody, including potential terrorists, to be able to create entirely novel life forms — new creatures? Do we want the teenager next door to be creating Godzilla in the bathtub? I don't want that."

She also worries about genetically engineered plants running amok, ruining the environment. And, she says, genetically engineering people would be even worse.

"Many of the figures in the synthetic biology field are not shy at all about embracing that prospect that we're going to use synthetic biology to redesign humanity and to engineer the traits in our children," she says. "And that I find extremely disturbing."

But others say those kinds of fears are exaggerated.

"Like every other technology, we need to be paying attention to how it's used," says Rob Carlson, a biotechnology analyst at Seattle-based Biodesic. But "it is not intrinsically more dangerous than other technologies," he adds. "And, in fact, if you wanted to do harm, there are many easier ways to go about causing harm than using synthetic DNA."

Heinz says his company is being very careful. It won't sell DNA to just anyone. And the potential benefits to society, he thinks, are huge.

"We can make DNA that would be used to make a virus that could target your cancer cells. And I think it can be helpful for dealing with some of the problems that humans have created. If we can make plants that can suck more carbon out of the atmosphere, we can deal with global warming," he says.

In addition, Heinz says he thinks "in general most people want children that are healthier than they were — maybe better. I think as a race, or as a species we have a goal of improving who we are."

Already, Cambrian Genomics and other companies are scaling up their operations to meet what many expect to be a growing demand for synthetic DNA.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

DNA 'Printing' A Big Boon To Research, But Some Raise Concerns

NPR Health Blog - Thu, 05/07/2015 - 4:56pm
DNA 'Printing' A Big Boon To Research, But Some Raise Concerns May 07, 2015 4:56 PM ET Listen to the Story 6:24
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Cambrian Genomics says that what it calls a DNA printer is essentially a DNA sorter — it quickly spots and collects the desired, tailored stretch of DNA.

Courtesy of Cambrian Genomics

Here's something that might sound strange: There are companies now that print and sell DNA.

This trend — which uses the term "print" in the sense of making a bunch of copies speedily — is making particular stretches of DNA much cheaper and easier to obtain than ever before. That excites many scientists who are keen to use these tailored strings of genetic instructions to do all sorts of things, ranging from finding new medical treatments to genetically engineering better crops.

"Many of the figures in the synthetic biology field are not shy at all about embracing that prospect that we're going to use synthetic biology to redesign humanity and to engineer the traits in our children. And that I find extremely disturbing."

"So much good can be done," says Austen Heinz, CEO of Cambrian Genomics in San Francisco, one of the companies selling these stretches of DNA.

But some of the ways Heinz and others talk about the possible uses of the technology also worries some people who are keeping tabs on the trend.

"I have significant concerns," says Marcy Darnovsky, who directs the Center for Genetics and Society, a genetics watchdog group.

A number of companies have been taking advantage of several recent advances in technology to produce DNA quickly and cheaply. Heinz says his company has made the process even cheaper.

"Everyone else that makes DNA, makes DNA incorrectly and then tries to fix it," Heinz says. "We don't fix it. We just see what's good, what's bad and then we use the correct pieces."

Shots - Health News Chemists Expand Nature's Genetic Alphabet Science DNA Transplant Transforms Bacteria

The company does that by putting chunks of their DNA on tiny metal beads that emit different colors. That lets a computer scan millions of pieces of DNA to find the right ones.

"So we just take a picture, change a filter, take a picture, change a filter, take a picture, change a filter. And we read the sequences," he says.

It's basically a high-tech version of a spell-checker.

Then Cambrian chooses and "prints" the correct stretch of DNA by firing a computer-controlled laser beam at a glass tray holding millions of these tiny metal beads, each one coated with DNA. The impact of the laser propels the bead carrying the correct DNA into a tray.

"The DNA laser 'printer' is essentially a sorter," he says. It can produce any strand of DNA, made to order, and Heinz can crank out a lot of DNA this way.

"We can make DNA that would be used to make a virus that could target your cancer cells. And I think it can be helpful for dealing with some of the problems that humans have created. If we can make plants that can suck more carbon out of the atmosphere, we can deal with global warming."

So far, the company's main customers are drug companies, which use the strings of DNA Cambrian Genomics makes to do things like genetically engineer microbes to try to find new medicines.

"They may be interested in making a protein that attacks a cancer cell with some kind of killer payload," he says.

Other users are genetically engineering plants to try to make them grow better. But Heinz envisions a day when mass-produced DNA can genetically engineer people — or let anyone use DNA like computer code to design their own organisms.

"I think some people will find the process of designing and making organisms just fun, in and of itself," he says.

But this sort of talk makes some people nervous.

"Heinz talks openly about everybody being able to create entirely novel creatures," Darnovsky says. "Is that what we want? Do we want anybody, including potential terrorists, to be able to create entirely novel life forms — new creatures? Do we want the teenager next door to be creating Godzilla in the bathtub? I don't want that."

She also worries about genetically engineered plants running amok, ruining the environment. And, she says, genetically engineering people would be even worse.

"Many of the figures in the synthetic biology field are not shy at all about embracing that prospect that we're going to use synthetic biology to redesign humanity and to engineer the traits in our children," she says. "And that I find extremely disturbing."

But others say those kinds of fears are exaggerated.

"Like every other technology, we need to be paying attention to how it's used," says Rob Carlson, a biotechnology analyst at Seattle-based Biodesic. But "it is not intrinsically more dangerous than other technologies," he adds. "And, in fact, if you wanted to do harm, there are many easier ways to go about causing harm than using synthetic DNA."

Heinz says his company is being very careful. It won't sell DNA to just anyone. And the potential benefits to society, he thinks, are huge.

"We can make DNA that would be used to make a virus that could target your cancer cells. And I think it can be helpful for dealing with some of the problems that humans have created. If we can make plants that can suck more carbon out of the atmosphere, we can deal with global warming," he says.

In addition, Heinz says he thinks "in general most people want children that are healthier than they were — maybe better. I think as a race, or as a species we have a goal of improving who we are."

Already, Cambrian Genomics and other companies are scaling up their operations to meet what many expect to be a growing demand for synthetic DNA.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Are You Sick, And Sick Of Hearing 'Everything Happens For A Reason'?

NPR Health Blog - Thu, 05/07/2015 - 4:56pm
Are You Sick, And Sick Of Hearing 'Everything Happens For A Reason'? May 07, 2015 4:56 PM ET Listen to the Story 3:00
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Courtesy of Emily McDowell Studio

When a friend or loved one gets sick — really, seriously sick — it's hard to know what to say. So some of us say nothing. Which seems better than saying the wrong thing, though people do that too.

Emily McDowell has heard it all.

Courtesy of Emily McDowell Studio

Los Angeles graphic designer Emily McDowell's solution to this dilemma are what she calls Empathy Cards. When someone is seriously ill, she says, the usual "Get Well Soon" won't do. Because you might not, she says. At least not soon.

McDowell knows this from experience. She's a 15-year survivor of Hodgkin lymphoma. She was just 24 when she was diagnosed.

"The most difficult thing about my illness was the fact that it was so lonely," she says. One of the reasons was "friends and family either disappearing because they didn't know what to say or well-intentioned people saying the wrong thing. So one of the most difficult things about being sick was feeling really alienated from everyone that I knew."

McDowell says she often got well-meaning advice on Internet "cures." "The thing that I felt when it was happening to me was: 'I also have the Internet. And I really appreciate you trying to help, but believe me, I've spent way too many hours Googling my own condition and any possible treatments. And I've made the decisions to do the things that I'm doing because I felt like they were the best choices for me.' "

Courtesy of Emily McDowell Studio

And then there's "Everything happens for a reason." With time and distance, some people do come to that conclusion on their own, McDowell says. But "hearing that immediately after some shocking or terrible thing happens in your life is generally not what people want to hear."

What is it with people who respond to the news of your dire prognosis with more bad news? That was the impetus for "When life gives you lemons, I won't tell you a story about my cousin's friend who died of lemons."

"This is a weird thing that people do. When they found out ... that I had cancer, it was 'Oh yeah, so and so I know had cancer and they died.' ... It's like sort of knee-jerk 'Oh, I can relate to this' and then they don't really think about the ending. ... But it's really surprising how many people this happens to and how common that is as a reaction."

And wouldn't it be great if no one ever referred to your illness as a "journey"? "With time and distance some people do come to that conclusion on their own that this ... feels like a journey," McDowell says. "But a lot of people really feel like 'If this is a journey I'd like my ticket refunded,' or 'This is a journey to hell and back.' "

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Ebola Hides In The Eyes Of A Man Who Was Considered Cured

NPR Health Blog - Thu, 05/07/2015 - 4:11pm
Ebola Hides In The Eyes Of A Man Who Was Considered Cured May 07, 2015 4:11 PM ET Listen to the Story 6:23
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iStockphoto

Ebola virus has once again figured out how to surprise and confound humans. It attacked the eyes of a doctor weeks after he had been deemed cured and virus-free.

The doctor, 43-year-old Ian Crozier, had contracted Ebola while working in Sierra Leone and was flown back to Emory University Hospital in Atlanta last September, desperately ill.

Weeks of intensive treatment saved Crozier's life. But soon after leaving the hospital, he started to have problems with his eyes. There were a burning sensation, a feeling that there was something stuck in his eye and sensitivity to light.

Shots - Health News No, Seriously, How Contagious Is Ebola?

One month later, Crozier suddenly suffered blurred vision, pain and inflammation in his left eye. Eye doctors call this uveitis, an inflammation inside the eye that can cause blindness.

When doctors tested the aqueous humor, the watery substance that sits atop the eye of the lens, it tested positive for Ebola.

They were able to save the eye, but it took months for the man's vision to recover.

"This case highlights an important complication of [Ebola] with major implications for both individual and public health," write the authors of the report, which was published Thursday in the New England Journal of Medicine.

Goats and Soda Ebola Survivor: The Best Word For The Virus Is 'Aggression'

The doctors don't know just how Ebola is able to hide and replicate in the eyes when the body has defeated it elsewhere. But the eyes are body parts that evolved to have adaptations in the immune system that discourage inflammation but might also make them more vulnerable.

"If you had a mosquito bite on your retina it would blind you," says Dr. Russell Van Gelder, chairman of ophthalmology at the University of Washington Medicine and president of the American Academy of Ophthalmology. So eyes are "immune privileged"; they don't respond to threats with inflammation like the skin and other body parts do.

"So it's not surprising that when a virus gets in the eye, it can hide from the surveillance of the immune system and bide its time," Van Gelder tells Shots. Cytomegalovirus and herpes viruses also can cause hard-to-fight eye infections.

Goats and Soda A Man Said To Be Ebola-Free Could Still Infect A Partner During Sex

Male testes are another immune-privileged organ, and it looks like semen can harbor Ebola virus for many months. Last week NPR's global health and development blog reported on a woman who was infected after having sex with an Ebola survivor.

Having an Ebola eye infection isn't likely to pose a similar risk, Van Gelder says. The doctor's tears and conjunctiva tested negative for the virus, even while it was replicating inside the eye.

it's not the first time that Ebola has turned up in people's eyes long after the fact. After an Ebola outbreak in the Democratic Republic of Congo in 1995, 15 percent of 71 people being studied came down with eye problems while convalescing.

Because tens of thousands of people survived the Ebola outbreak in Africa, there could be thousands of people who risk blindness from delayed eye infections, Van Gelder says.

"This could become a major health issue much in the way that in the height of the AIDS outbreak in the 1980s, cytomegalovirus retinitis was a big issue," he adds. "About one-third of people would go blind before they died of HIV."

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Ebola Hides In The Eyes Of A Man Who Was Considered Cured

NPR Health Blog - Thu, 05/07/2015 - 4:11pm
Ebola Hides In The Eyes Of A Man Who Was Considered Cured May 07, 2015 4:11 PM ET Listen to the Story 6:23
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iStockphoto

Ebola virus has once again figured out how to surprise and confound humans. It attacked the eyes of a doctor weeks after he had been deemed cured and virus-free.

The doctor, 43-year-old Ian Crozier, had contracted Ebola while working in Sierra Leone and was flown back to Emory University Hospital in Atlanta last September, desperately ill.

Weeks of intensive treatment saved Crozier's life. But soon after leaving the hospital, he started to have problems with his eyes. There were a burning sensation, a feeling that there was something stuck in his eye and sensitivity to light.

Shots - Health News No, Seriously, How Contagious Is Ebola?

One month later, Crozier suddenly suffered blurred vision, pain and inflammation in his left eye. Eye doctors call this uveitis, an inflammation inside the eye that can cause blindness.

When doctors tested the aqueous humor, the watery substance that sits atop the eye of the lens, it tested positive for Ebola.

They were able to save the eye, but it took months for the man's vision to recover.

"This case highlights an important complication of [Ebola] with major implications for both individual and public health," write the authors of the report, which was published Thursday in the New England Journal of Medicine.

Goats and Soda Ebola Survivor: The Best Word For The Virus Is 'Aggression'

The doctors don't know just how Ebola is able to hide and replicate in the eyes when the body has defeated it elsewhere. But the eyes are body parts that evolved to have adaptations in the immune system that discourage inflammation but might also make them more vulnerable.

"If you had a mosquito bite on your retina it would blind you," says Dr. Russell Van Gelder, chairman of ophthalmology at the University of Washington Medicine and president of the American Academy of Ophthalmology. So eyes are "immune privileged"; they don't respond to threats with inflammation like the skin and other body parts do.

"So it's not surprising that when a virus gets in the eye, it can hide from the surveillance of the immune system and bide its time," Van Gelder tells Shots. Cytomegalovirus and herpes viruses also can cause hard-to-fight eye infections.

Goats and Soda A Man Said To Be Ebola-Free Could Still Infect A Partner During Sex

Male testes are another immune-privileged organ, and it looks like semen can harbor Ebola virus for many months. Last week NPR's global health and development blog reported on a woman who was infected after having sex with an Ebola survivor.

Having an Ebola eye infection isn't likely to pose a similar risk, Van Gelder says. The doctor's tears and conjunctiva tested negative for the virus, even while it was replicating inside the eye.

it's not the first time that Ebola has turned up in people's eyes long after the fact. After an Ebola outbreak in the Democratic Republic of Congo in 1995, 15 percent of 71 people being studied came down with eye problems while convalescing.

Because tens of thousands of people survived the Ebola outbreak in Africa, there could be thousands of people who risk blindness from delayed eye infections, Van Gelder says.

"This could become a major health issue much in the way that in the height of the AIDS outbreak in the 1980s, cytomegalovirus retinitis was a big issue," he adds. "About one-third of people would go blind before they died of HIV."

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Screening Rates Stalled For Common Cancers

NPR Health Blog - Thu, 05/07/2015 - 3:02pm
Screening Rates Stalled For Common Cancers May 07, 2015 3:02 PM ET $(function() { var pymParent = new pym.Parent( 'responsive-embed-cancer-screenings-20150507', 'http://apps.npr.org/dailygraphics/graphics/cancer-screenings-20150507/child.html', {} ); });

When it comes to cancer, the right screening test at the right time can go a long way toward catching the disease while it can be stopped.

But many Americans aren't getting recommended screening tests for colorectal, breast and cervical cancer. In fact, there's been a notable lack of progress in reaching national screening goals, according to the Centers for Disease Control and Prevention.

Only 72.6 percent of women between 50 and 72 said they were up to date on mammograms in 2013. The proportion of eligible women who got the breast cancer test is 8.5 percentage points short of the goal that federal public health agencies have set for 2020. And the mammogram trend is flat.

Shots - Health News The Great Success And Enduring Dilemma Of Cervical Cancer Screening

Results for the Pap test to detect cervical cancer were a little better but still short of the goal. In 2013, 80.7 percent of women said they had recently had a Pap test. The proportion was 12.3 percentage points below the 2020 target. What's more, use of the Pap test has "declined significantly," dropping 5.5 percentage points between 2000 and 2013, wrote the authors of the CDC report in the latest issue of Morbidity and Mortality Weekly Report.

The screening rate for colorectal cancer also fell short of the mark. Some 58.2 percent of people ages 50 to 75 had been recently screened for colorectal cancer in 2013. That's far below the national goal of 70.5 percent in 2020. And, overall, colorectal cancer screening rates are flat going back to 2010, after rising sharply starting in 2000.

"The first reaction is that we've reached this plateau, and it's hard to get off the plateau," says Dr. Richard Wender, chief cancer control officer at the American Cancer Society. The findings, he tells Shots, "are a call to action to recommit to the proven cancer screening tests."

A lengthening of the interval between cervical cancer screens will make it easier for women to stay current, he says. As for colorectal cancer screening, he says, that it's important to consider a range of options, including fecal immunochemical test, which is inexpensive and less invasive than a colonoscopy. "We're not going to get off this dime if we only offer colonoscopy," he says.

Shots - Health News Federal Panel Revisits Contested Recommendation On Mammograms

Wender also says that ongoing debate about mammogram guidelines has obscured the agreement over the value of the test every other year for women ages 50 to 74.

The CDC report, based on an annual federal survey, also identified notable disparities in screening by income, insurance status, race and ethnicity. Lack of insurance and low income, in particular, hinder compliance with screening recommendations.

The full implementation of the Affordable Care Act could make a difference. "I think expansion of insurance rolls is one of the most important reasons for optimism," Wender says. "Insurance is not all it takes, but it's a huge facilitator."

$(function() { var pymParent = new pym.Parent( 'responsive-embed-cancer-screenings-groups-20150507', 'http://apps.npr.org/dailygraphics/graphics/cancer-screenings-groups-20150507/child.html', {} ); }); Copyright 2015 NPR. To see more, visit http://www.npr.org/.
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Losing A Hospital In The Heart Of A Small City

NPR Health Blog - Thu, 05/07/2015 - 3:48am
Losing A Hospital In The Heart Of A Small City May 07, 2015 3:48 AM ET

from

Sarah Jane Tribble Listen to the Story 3:25
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Ann Allen (right) and Marie Birsic (left) take part in a demonstration to prevent the closure of Lakewood Hospital on Cleveland's West Side. Birsic says the neighborhood will "go down into a ghost town" once the hospital is turned into an outpatient center.

Sarah Jane Tribble/WCPN

Lakewood Hospital, which opened its doors in 1907, is slated to close. Across the country, small hospitals are closing as patient numbers and demographics shift with changing economies.

Sarah Jane Tribble/WCPN

In a leafy suburb of Cleveland, 108-year-old Lakewood Hospital is expected to close in the next two years, for economic reasons. Mike Summers points to the fourth-floor windows on the far left side of the historic brick building. He recalls spending three weeks in one of those rooms. It was Christmas 1965 and Summers had a broken hip.

"I remember hearing Christmas bells from the church across the street," he says.

Summers was born at this city-owned hospital. His sister was born here. This hospital has a special place in his heart. But then he became mayor of Lakewood four years ago, and he realized the hospital was a financial liability to the small city, which has seen a sharp increase in poverty levels in the past two decades.

"I've grown to understand the situation we are in is not unique. There are considerable forces at play and we are in the middle of all of them," Summer says. "And a lot of communities are just like us."

Shots - Health News Cleveland Hospitals Grapple With Readmission Fines

Lakewood Hospital is this community's biggest employer, with 1,000 workers. It was long a rich source of municipal revenues, even as manufacturing jobs left the region.

And, for generations, the hospital has been a source of pride for residents. Nearly everybody has a personal connection to it — through birth, illness or employment — and hundreds turned out for a community meeting in January, heckling city leaders and hospital executives who tried to make a case for the closure.

The Cleveland Clinic is one of the largest nonprofit health systems in the U.S. It has operated Lakewood for the city but has lost money since 2005.

Shots - Health News Georgia Looks To Reopen Some Closed Hospitals As ERs

Executives say they need to close the hospital and replace it with a smaller outpatient health center and emergency room. Residents with inpatient needs can go to other nearby Cleveland Clinic-owned hospitals, including one being built in a more affluent suburb. Cleveland Clinic Chief Executive Officer Dr. Toby Cosgrove addressed the meeting.

"It is our intent to keep Lakewood Hospital fully functioning until Avon Hospital opens in September 2016," he said.

Still, residents are pursuing legal action. The city has responded to the residents' action, and Lakewood's leaders say they'd like the community to focus on how to overcome the loss of the hospital, rather than a legal battle.

Lakewood is going through something that is increasingly common across the country. Like other hospitals, Lakewood is admitting fewer patients who aren't staying as long — two economic indicators of how much the hospital is used and how much money it is making.

Shots - Health News When Hospitals Close, Frequent Fears About Care Aren't Realized

The economic status of the patients is also, indirectly, a factor, says Paul Ginsburg, chairman of medicine and public policy at the University of Southern California. "Unfortunately as a society we've created some powerful incentives," Ginsburg says. "Hospitals are paid much better to treat privately insured patients than anyone else. After that comes Medicare, and the least payment is for Medicaid patients — and, of course, the uninsured. That's virtually no payments."

Lakewood has become a poster child for the challenges of inner-ring, economically strapped suburbs.

A Brookings Institution report in 2012 on the nation's growing suburban poverty includes Lakewood. It notes that between 1999 and 2010, free and reduced-price lunches for high school students shot up from 9 percent to 46 percent.

Summers says that there is no question Lakewood Hospital's percentage of privately insured patients has dropped in recent years.

"In 2000 ... maybe 4 or 5 percent of residents were at the poverty level," he says. "Today we're pushing 16 percent. It's been fairly dramatic."

This story is part of NPR's reporting partnership with WCPN and Kaiser Health News.

Copyright 2015 Cleveland Public Radio. To see more, visit http://www.wcpn.org.
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Fla. Governor Leaves Meeting With U.S. Health Secretary Empty-Handed

NPR Health Blog - Wed, 05/06/2015 - 8:17pm
Fla. Governor Leaves Meeting With U.S. Health Secretary Empty-Handed May 06, 2015 8:17 PM ET

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Phil Galewitz

Florida Gov. Rick Scott speaks Wednesday with reporters in Washington, D.C., after a meeting with Sylvia Burwell, head of the Department of Health and Human Services.

Alex Wong/Getty Images

Florida Gov. Rick Scott paid a high-stakes visit to Washington D.C. on Wednesday, in hopes of persuading the Obama administration to continue a program that sends more than $1 billion in federal funds to Florida each year to help reimburse hospitals for the costs of caring for the state's poor. Uncertainty about the future of the program, slated to end June 30, has created a hole in the state budget and paralyzed Florida's legislature.

"We had a good conversation ... but we don't have a resolution," the Republican governor told reporters after an hour-long, private meeting with U.S. Secretary of Health and Human Services Sylvia Burwell.

Sec. Sylvia Burwell, head of HHS, says Florida was alerted a year ago that federal funding of the program to reimburse hospitals would end June 30, 2015.

Alex Wong/Getty Images

Burwell's office issued a written statement after the talks, saying that Florida's request "falls short of the key principles HHS will use in considering proposals regarding uncompensated care pool programs."

Gov. Scott contends that a letter HHS sent to Florida last month linked the expiration of the fund for hospitals with Florida's refusal to exercise its option to expand health insurance coverage through Medicaid. Scott filed a suit against HHS last week, alleging that the federal government is trying to coerce the state into expanding Medicaid. The governors of Texas and Kansas, which receive similar funding to help their hospitals, have said they support Florida's lawsuit.

But after meeting with Scott, Burwell insisted that "whether a state receives federal funding for an uncompensated care pool is not dependent on whether it expands Medicaid." Whether to expand Medicaid, or not is "a state decision," she reaffirmed.

That seemed to leave open the question of whether some funding might still be available for the hospital program — albeit at a lower level — if a state does not expand.

Scott said he needs an immediate answer from HHS on how much money, if any, the administration might provide, so that he and Florida's legislature can complete their budget deliberations.

Shots - Health News Florida Leads Insurance Sign-Ups, Despite Political Opposition To Overhaul

"We need our answer right now," he said.

Burwell indicated Scott might have to wait a while longer.

"HHS heard the Governor's request for a timely response to help the state meet its budget timeline," her office said in the written remarks. "HHS believes completion of the public comment period, on-going discussions with the state, and the state's submission of its proposal to CMS are the next steps in the process."

The 30-day comment period has about two weeks remaining.

Florida is one of 21 states that chose not to expand Medicaid under the Affordable Care Act. That left about 800,000 Floridians without health insurance.

Shots - Health News Florida's House Quits Early, At Impasse Over Medicaid Expansion

Burwell has said HHS prefers that the state expand health care coverage via Medicaid, rather than continue full federal funding of the low-income pool that subsidizes hospitals.

The bitter dispute over Medicaid expansion between the Republicans who control Florida's House and the Republicans who control the state's Senate led the Florida legislature to adjourn last week without passing a state budget for the fiscal year that begins July 1. Lawmakers are expected to return to Tallahassee in June to resume budget deliberations.

Florida's House has adamantly opposed expanding Medicaid, with House Speaker Steve Crisafulli last week calling it "a broken system, with poor health outcomes, high inflation ... federal strings, and no incentive for personal responsibility for those who are able to provide for themselves."

Shots - Health News Expanding Medicaid Trims Hospitals' Costs Of Caring For Uninsured

But on Wednesday, Scott had good things to say about how well Medicaid was working in Florida. In the past two years, the state has turned over most of the Medicaid program's operations to private Medicaid health plans.

"We now have a program that works," Scott said. "We know what it's going to cost us. We have insurance companies responsible for taking care of Medicaid recipients, and we have Medicaid recipients who know who is responsible for their care. ... And we now have a budget surplus."

Nonetheless, Scott said he doesn't trust the federal government's promise to fund Medicaid expansion under the health law; he fears the state will be on the hook to pick up too much of the cost. The federal government is paying all the costs through 2016, and then is to pay at least 90 percent of the costs.

A year ago, federal officials warned Florida leaders that the low-income pool that subsidizes hospitals would end this year, but Scott included the money in his proposed state budget anyway.

Copyright 2015 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
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